Self-Directed CBT Outperforms Traditional Therapy for Chronic Pain, Yale Study Finds

A Yale-led clinical trial found that a self-directed cognitive behavioral therapy program outperformed traditional clinician-delivered CBT for patients with chronic pain.

The study, published in JAMA, tested a program called Cooperative Pain Education and Self-management, or COPES, developed by Alicia Heapy, PhD, associate professor of psychiatry at Yale School of Medicine.

Nearly a quarter of adults in the United States experience chronic pain. Access to psychologists who specialize in treating it is limited, and many patients face barriers including distance from specialists and scheduling conflicts.

The trial enrolled more than 700 patients with chronic pain from Veterans Health Administration healthcare systems across the country. Participants either received typical care from VHA clinicians or completed the COPES program over 11 weeks.

Patients in COPES received handbooks teaching pain management skills such as relaxation and healthy sleep strategies. They also participated in a walking program designed to gradually increase their daily steps. Each day, participants answered a brief survey about their progress, and they received weekly voice messages from a trained coach offering personalized feedback.

Researchers measured how much pain interfered with daily activities at four, six, and 12 months after the start of treatment. Participants in COPES showed greater improvement at every time point. The program also produced better results for sleep and depressive symptoms.

"The pattern was very clear. At each time point across almost all outcomes, the self-directed treatment was better," Heapy said.

She believes the convenience of COPES contributed to its stronger results. Participants in the self-directed group were able to complete more sessions than those in traditional CBT.

COPES is currently available at VHA healthcare systems in Connecticut, Massachusetts, and Maine.